Therapy

Traditional Therapy Outcomes vs. Challenges and Contests

Two different approaches to change. Both are effective in their own way.

Posted May 05, 2020

In this article, I'm going to detail two different ways to create change in behavior and outcomes. I will also provide my own experiences with each of these methods of change.  

  • The first is traditional psychotherapy, where you individually (or with family) discuss your challenges and with help, make plans to improve.
  • The second is group challenges and contests, which are becoming more mainstream, are often incentive-based, and used in many industries including fitness, innovation, healthcare, and others. 

As you will see, I believe both methods are useful to change. Both methods require action and external support.

Effective Therapy and Outcomes

According to a recent meta-analysis, traditional psychotherapy often produces moderate-sized effects among multiple disorders, including substance and alcohol use, eating disorders, and mood disorders. However, in order for therapy to be effective, the patient's pre-therapy "state of change" really matters. No two patients show up to therapy with the same motivation or readiness to change. 

There are five stages of change. The higher up the stages an individual is before entering therapy, the more likely will they will be successful in and through therapy. These five stages are:

  • Precontemplation is the stage where there is no intention to change behavior in the foreseeable future. Most patients in this stage are unaware or under‐aware of their problems. Families and others are often aware of the problem and when such an individual enters therapy, it is usually due to the coaxing of family or friends, who threaten the relationship in some way.
  • Contemplation is the stage where patients are aware that a problem exists and are seriously thinking about overcoming it. However, they have yet to make a commitment to take action. These individuals are focused on the positive aspects of their dysfunctional behavior and are also focused on the amount of effort, energy, and loss it will cost to overcome it. People can remain stuck in the contemplation stage for long periods. Serious consideration of the problem characterizes contemplation.
  • Preparation is a stage that combines intention and behavioral criteria. Individuals are intending to take action in the near future and are currently making "baby steps." There may be some reductions in problematic behaviors, but these individuals have not met the criteria for "effective action," such as abstinence to addiction or remission of depression.  
  • Action is the stage where individuals modify their behavior, experiences, and/or environment to overcome their problems. Alteration of the problem made in the action stage tends to be most visible and receive the greatest external recognition. Individuals are in the action stage if they have successfully changed the dysfunctional behavior for a period from 1 day to 6 months. 
  • Maintenance is the stage where individuals work to prevent relapse and consolidate the gains attained during the "action" stage. For some behaviors, such as addictions, maintenance can last a lifetime; for other behaviors, maintenance can end at 3 to 9 months. The goal of maintenance is stabilizing behavior change and avoiding relapse.

I myself have done a great deal of therapy and it has been effective at helping me achieve my own personal goals. During my undergraduate in college, I sought therapy, both group and individual, for the purpose of becoming more emotionally open and vulnerable in relationships. My goal was to prepare for marriage. I had grown up in a broken home filled with lots of trauma and felt I had unresolved emotional challenges from my teens, which were getting in my way of creating closely connected relationships with those I sought to date. Within four months of starting therapy, I met the woman who became my wife, whom I now have five children with. 

Near the end of my time in graduate school several years later, my wife and I began therapy to help us clarify some big decisions we needed to make. We also desired to become more closely connected as a couple. We did weekly therapy sessions for about four months, and the result was that my wife dropped out of her Master's Program in Social Work to focus on our growing family (she was pregnant with twins and we had recently adopted three siblings from the foster system). We also determined that I would go up to Clemson, South Carolina, for several weeks by myself to focus on and complete my dissertation, which had been looming for over a year.

We both executed those plans to great success and we both feel great about the decisions we made. I completed my Ph.D., Lauren had a great pregnancy, and since we did those four months of therapy, which was around a year ago, we feel much closer in our relationship. Therapy very much helped us with this.

Group Challenges and Contests: A Different Approach to Change

Weight loss "challenges" have been the most popular form of challenges in recent decades. Research shows that large corporations have engaged in various forms of weight loss challenges, such as 12-week challenges. These challenges have generally been viewed as positive and "effective" for those who engage.

Other research has looked at web-based weight loss challenges, which have also produced effective results for those who engage. Based on this research, the authors of the study conclude that web-based weight loss programs are more effective when additional strategies are incorporated, such as short-term challenges, social support, and endorsements from celebrities. 

In the fitness world, "challenge"-based fitness has become highly popular, such as the Spartan Races and Crossfit styles of fitness. There is an objective or challenge to be conquered. Recently, there have been many entrepreneurs and online trainers who have engaged audiences using short-term "challenges" or "competitions" to increase engagement and motivation. Pedro Adao, the founder of 100X Academy, is one of the world's leading experts in creating online "challenges."

During the COVID-19 crisis, Pedro created a 30-day challenge to help people build an online business in an ethical way. He used paid advertising on Facebook to get people interested in the challenge. Nearly 20,000 people joined the challenge, wherein Pedro gave free daily motivational training. They became part of a Facebook group with others sharing their support and success. Through the challenge, people began making progress and achieving their goals. They became more excited about Pedro's work, and many purchased his higher-commitment programs. The result was that in less than 30 days, Pedro made well over 7-figures income by creating a digital, web-based challenge. 

The reason challenges are powerful, Pedro argues, is that people who engage in such challenges do so with the intention of "action" from the start. You wouldn't engage in contests without the implied action and social support to seek the desired result. Challenges are also time-bound, from 5 days to 90 days max, for best results. Pedro also suggests the person running or leading the challenge should do "live" web training, preferably daily. 

Joe Polish is one of the world's leading experts on doing incentive-based contests, which are very similar to challenges. With a contest, though, there is a prize and a winner, or multiple "winners." For multiple decades, Joe has done contests, first starting with carpet cleaners and now more generally among entrepreneurs, to improve their businesses. He would give away nice cars as the contest prize for people who made the most progress.

As weird as it sounds, people often need a reason or event to make desired changes. The contest can become that reason. Often, these contests became the catalyst for changing people's lives, not just their business. People used the contest as an opportunity to get in shape, or to improve their relationships. Joe actually helped me do a contest once for a book I launched, and through the contest, we helped people make huge progress on addictions and other goals they had. I was surprised to find that many people who had struggled for decades, whether with weight or something else, saw the contest as something they could get excited about. 

When I first started blogging online, there was a contest being run by a successful blogger, Jon Morrow. He had a huge online presence, and he said that the person who submitted the best blog post to him by a given date, he would share the blog post with his huge audience. That contest got me excited, and I wrote the absolute best article I could. I didn't end up winning, but that article was published on a different platform and ended up getting tens of millions of views. That article changed the trajectory of my writing career and I would never have written it if it wasn't for the contest.

Conclusion

All forms of change require action. Contests and challenges are short-term in duration and have the implied intention of action from the beginning. There is a clear end date and clear outcome that those engaged are seeking, whether that be weight loss, starting a business, or improving their life in some other way.

In both therapy and challenges, there is some form of external support, whether from a coach or professional therapist. Having an embedded timeline, which is more akin to contests and challenges, can really help motivation. Moreover, having a clear outcome and a social support group can also greatly enhance motivation. Finally, the emphasis on "small" and "daily" wins, which is hugely emphasized in challenges can build confidence and psychological flexibility, which can have a long-term impact. 

References

Hutchesson, M. J., Collins, C. E., Morgan, P. J., & Callister, R. (2013). An 8-week web-based weight loss challenge with celebrity endorsement and enhanced social support: observational study. Journal of medical Internet research, 15(7), e129.

Krebs, P., Norcross, J. C., Nicholson, J. M., & Prochaska, J. O. (2018). Stages of change and psychotherapy outcomes: A review and meta‐analysis. Journal of clinical psychology, 74(11), 1964-1979.

Vasquez, K., Malhotra, R., Østbye, T., Chan, M. F., Amin, H., Khoo, G., ... & Thilagaratnam, S. (2015). Extent and correlates of change in anthropometric and fitness outcomes among participants in a corporate team–based weight loss challenge in Singapore: lose to win 2009. Asia Pacific Journal of Public Health, 27(2), NP425-NP436.